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CHART NO. <br />everett <br />City of Everett \S�Yl <br />Sewer Application and Permit <br />NO. 26402 T DATE <br />Service Address H y � 1 R t �`�''� Utility Account No. <br />Billing <br />City, State, <br />Permit <br />Connection Charge(s) <br />Owner (Mortgagor) Total Fee______ <br />,Billing Name <br />Connection By <br />Signed Customer <br />DESCRIPTION: <br />Lot Block <br />Plat <br />Unplatted Description_ <br />'r . Onemi}• Ld - t n , r <br />r r_ _..... _ _ T <br />Remarks: ell A/.-11 <br />Fes_ <br />IMPORTANT! <br />CALL 1.800-424-5555 48-HOURS <br />PRIOR TO DIGGING <br />CALL 259-8811 FOR INSPECTION <br />SEE SKETCH ATTACHED <br />Sewer <br />Monthly Sewer <br />Monthly Sewer Constr. <br />Abutting Lot Line <br />N, S, E, W. <br />Approved By <br />City Engineer <br />Issued N M I I I e r <br />Inspection By <br />Date Inspected G � /3 8 NO. 26402 <br />UTILITY BILLING <br />